Walter Reed scandal shines light on health care issues

March 8, 2007

Editorial

The bigger scandal is that it took a hard-hitting expose in the hometown newspaper of the federal leviathan to bring what might actually be some effective attention to the deplorable conditions faced by wounded military personnel at Walter Reed Army Medical Center.

As the Washington Post revealed in a subsequent story, the attention paid to Walter Reed sparked a torrent of e-mails and phone calls from wounded warriors and veterans who have tried for years to call attention to equally deplorable conditions at military and Veterans Administration hospitals all over the country.

Soldiers and their families, faced with downright unsanitary conditions, bureaucratic runarounds, deteriorating facilities, lack of decent equipment, have been writing for years to members of Congress, to generals and Defense Department officials, seeking improvements — or even the courtesy of attention. Until a confluence of events occurred — a well-documented expose, a Democratic Congress eager to hold a Republican administration’s feet to the fire, an ABC newsman who had been grievously wounded in Iraq and experienced the military hospital system himself and did a TV special, a new defense secretary — nothing much happened.

Even now, there’s no guarantee of long-term improvement, despite President Bush’s having appointed a commission headed by former Sen. Robert Dole and former HHS Secretary Donna Shalala to look into the care of wounded warriors and veterans.

Indeed, the best bet is that after a flurry of attention and some improvements, the system after a few years will once again lapse into deterioration and neglect.

Virtually every American and certainly every elected official believes the government owes those wounded in war the best possible care. It became obvious early in the Iraq war that, thanks to the skills of battlefield surgeons and advances in medical knowledge, large numbers of soldiers who in previous wars would simply have died in the field were being saved. But the downside to this welcome development is that many of them would require medical attention for years to come or for the rest of their lives.

There is little disagreement that most of the doctors and especially the nurses in military hospitals are highly skilled, highly motivated, and dedicated to the welfare of their patients. Mixed in with complaints about rats, roaches, unsanitary conditions and peeling paint are stories of remarkable feats of medical skill and unfailing compassion on the part of military medical personnel.

So how, when everyone wants these facilities to be excellent, and most of those who staff them work so hard and so well, did they come to such a sorry pass?

The short answer is these are government institutions that face the perverse incentives every government institution faces. With no effective competition and without the discipline of a profit-and-loss mechanism that could lead to inefficient institutions being forced to shut down, the tendency, despite the efforts of many within the system, is to lapse into mediocrity and worse.

At Walter Reed, VIPs sometimes received treatment in the main facilities, but they never saw Building 18, where the most deplorable conditions prevailed. As is so often the case with government institutions, simple maintenance, which is not obvious to the public until it is neglected for years, tended to be deferred.

As Donald Boudreaux, chairman of the economics department at George Mason University said, “When you’re working with other people’s money there is no incentive to allocate resources wisely. There’s no personal feedback mechanism, no way to set priorities intelligently, no entrepreneurial fire in the belly to figure out how to do things in the most efficient, effective way possible, because there’s no direct reward for such innovative thinking.”

Indeed, questioning the old ways is more likely to be punished than rewarded.

The usual substitute in government for the discipline of the marketplace is oversight by higher-ups, but too often this simply translates into new layers of bureaucracy that demand endless reports and paperwork but no genuine accountability. This frustrates the best-intentioned professionals and workers, who all too often resign themselves to the fact that “the system” will never change and they’ll just have to endure.

The blog world, or at least the left side of it, has jumped on what some call privatization efforts at the hospital as the main culprit. That is disingenuous at best.

A few services at Walter Reed are contracted out, but there’s no effort to change the basic character of the government-military institution. It is that character that largely explains the long-term problems and widespread conditions that have come to light.

The remarkable thing is that despite the repeatedly documented shortcomings of military and veterans’ hospitals, which are the closest thing to fully socialized medicine we have in this country, a significant sector of the public believes that more pervasively socialized health care would be appropriate in what is now the semiprivate sector.